Normal and Abnormal Breast Exam Flashcards
Where does most of the glandular tissue exist in the female breast?
The upper outer quadrants
What are the 2 most common routes for metastasis in the breast?
Ipsilateral lymph node and Internal mammary nodes
What are the 4 congenital anomalies of the breast?
Absence of the breast
Accessory breast tissue along the milk line
Extra nipples (polythelia)
Accessory breast (polymastia)
What are the 2 most common breast complaints?
Breast pain and apparent mass
What are 2 risk factors for development of breast cancer (in terms of onset/cessation of menarche/menses)?
Early menarche (12> y/o)
Late cessation of menses (>55 y/o)
What are some common risks for breast cancer? (8)
Never breast fed Recent and long-tern use of oral-contraceptives Post-menopausal obesity H/O endometrial or ovarian cancer Alcohol consumption Increased height High socioeconomic status Ashkenazi Jewish heritage
Palpable breast masses always get…
A biopsy (FNA/core/excisional)
Mammography is able to detect… (2)
Lesions about 2 years before they become palpable
Inapparent masses of <1 cm
At what age is mammography best?
> 40 y/o
What is breast ultrasonography most useful in evaluating?
What age group is most appropriate?
Inconclusive mammogram findings
Young women (<40 y/o) and others with dense breast tissue
What are 2 unique functions of breast ultrasonography?
Allows for differentiation between cystic and solid lesions
Guidance when performing a core needle biopsy
Under which scenarios (3) would a breast MRI be appropriate?
In adjunct with mammography for suspicious masses
Post-cancer diagnosis for staging evaluation
Women at risk for breast cancer (BRCA mutations, etc.)
FNAB is useful for:
Determining solid vs. cystic masses
What kinds of fluids from FNAB would indicate mammography/US?
Bloody fluid should be sent for cytology and followed with mammography/US
Clear fluid does not require further evaluation
What should be done after FNA with cystic masses?
Return to clinical breast exam in 4-6 mo. if cyst completely disappears with aspiration
If cyst reappears or does not fully resolve, diagnostic mammogram/US and biopsy are indicated
How many samples are needed in a core biopsy? How big should they be?
3-6 samples about 2 cm. long
When does cyclic mastalgia begin and end?
It begins at the luteal phase and ends after onset of menses
What is non-cyclic mastalgia?
It is not associated with the menstrual cycle and may include tumors, mastitis or cysts or with some medicines
What medications are associated with non-cyclic mastalgia? (3)
Anti-depressants
Anti-hypertensives
Hormonal meds (OCPs)
What are 3 extra-mammary causes of mastalgia?
Chest wall trauma
Shingles
Fibromyalgia
What is the only FDA approved treatment for mastalgia?
What are its side effects?
Danazol
Menstrual irregularities, benign intracranial HTN, changes in blood sugar, deepening of voice, abnormal hair growth, weight gain
What 2 drugs may help in mastalgia?
Oral contraceptives
Depo Provera
What lifestyle modifications may help mastalgia symptoms? (6)
Properly fitting bra Weight loss Exercise Decreased caffeine intake Vit. E supplementation Evening of primrose oil
Nipple discharge is usually _______, but can be a sign of _______ or _______
Usually benign, but can be a sign of an endocrine disorder or cancer
Non-spontaneous, non-bloody (clear, green or yellow) and bilateral discharge is most consistent with…
Fibrocystic changes or ductal ectasia
What could a milky discharge be a sign of? In which patients is it common?
Common with childbearing, but can indicate hyperprolactinemia, hypothyroidism or medication-related response (oral contraceptives or psychotropics)
Bloody nipple discharge should be considered…
Cancer until proven otherwise
What is on the DDx for bloody nipple discharge?
How is it evaluated?
- Cancer: intraductal carcinoma or ductal carcinoma
- Benign intraductal papilloma
Breast ductography
What are the 3 categories of breast masses and what is the RR of developing cancer?
Non-proliferative: 1.0
Proliferative without atypia: 1.5-2.0
Proliferative with atypia: 8.0-10.0
What are fibrocystic changes?
A spectrum of changes observed in the normal breast present in about 50% of women: lobules of breast dilate and form cysts and cysts rupture and result in scarring and inflammation
What is adenosis?
Lobular growth with increased number of glands
What causes lactational adenomas?
A hormonal response
What are the most common benign tumor of the female breast?
Fibroadenoma
At what age do fibroadenomas develop?
What is their gross appearance?
How big are they usually?
Can they become malignant?
Late teens to early 20s
Solid, rubbery, mobile and typically solitary
Usually 2-4 cm but can be as big as 15 cm
Yes - complex cellular lesions have an increased risk
What is a galactocele?
When does it occur?
What is a complication?
What is the treatment?
A cystic dilation of duct filled with milky fluid
Occurs near time of lactation
Secondary infection that causes acute mastitis
Typically can be needle aspirated
What is sclerosing adenosis?
Increased fibrosis within the breast lobules
What are complex sclerosing lesions (radial scars)?
Tubules trapped within a dense stroma surrounded by radiating arms of epithelium
What are papillomas?
What ages do they appear?
What kind of discharge may result?
Intraductal growths
30-50 y/o
Serous or serosanguinous discharge
Which 4 lesions are considered “proliferative without atypia”?
Epithelial hyperplasia
Sclerosing adenosis
Complex sclerosing lesions (radial scars)
Papillomas
Is Lobular CIS (LCIS) pre-malignant?
No, but it is a risk factor
What is Ductal CIS?
Ducts filled with atypical epithelium which is an increased risk for developing invasive disease or reoccurance of DCIS
How are LCIS and DCIS treated usually?
Excision and followed with selective estrogen receptor modulators
What is the lifetime risk for developing breast cancer vs. the lifetime risk of dying from it?
Developing breast cancer - 1:8
Lifetime - 1:28
What are the risks of developing cancers in women with a BRCA1 and BRCA2 mutation?
BRCA1: 50% of early onset breast cancers and 90% of hereditary ovarian cancers
BRCA2: 35% of early onset breast cancers and a lower risk of ovarian cancer
In which patients is the Gail model not as useful?
In which patients might it be falsely elevated?
Women with high risk are counseled to explore what options?
Less useful in second degree relatives with breast cancer
Falsely elevated in patients with multiple breast biopsies
Women considered high risk (5-year risk of >1.7%) counseled on prophylactic therapy (chemoprevention, mastectomy, oophorectomy)
What is the most common to least common types of breast cancer?
- Ductal (70-80%)
- most common in women in 50s and spread to regional LNs - Lobular (5-15%)
- more likely to be multifocal and/or bilateral - Nipple - Paget’s disease presenting as superficial skin lesions (3%)
- Inflammatory breast cancer (1-4%)
- swelling, redness and induration of nearby tissue
What should be used in addition to staging to determine the prognosis of breast cancers?
Receptor status
Which oncogenes signify a worse prognosis? How common is it?
HER2/neu (20-30% of invasive cancers)
What therapy is used in all stages of breast cancer?
Adjuvant therapy - reduces reoccurence by 1/3 and reduces risk of death by 30%
Breast cancer follow-up schedule for..
First 2 years post diagnosis
After first 2 years
When do most reoccurences happen?
First 2 years post diagnosis: every 3-6 mo.
After first 2 years: annually
Within first 5 years after treatment
